The Affordability Gap: Care Cost Against Local Income

How to read this

The comparison is deliberately blunt. It sets a full year of care at the local modeled median against a full year of local median household earnings, before tax and before any other resource. It is a measure of the distance between local prices and local pay, not a household budget.

Very few families cover care from current income. Home equity, savings, long-term care insurance, veterans benefits, and eventually Medicaid all sit in between. What this ratio shows is how large that gap has to be filled from somewhere other than a paycheck.

The state ratio is the median of the city ratios inside that state, so a state with two priced cities is a much thinner reading than one with sixty. The city count sits in every row of the table so that thinness is visible rather than hidden.

High-income states are not automatically comfortable ones. Care prices tend to rise with local wages, which is why states at very different income levels can land close together on this ratio.

Methodology

For every city where we publish both a modeled assisted living median and a Census median household income, we multiply the monthly median by twelve and divide by that city's median household income. A result above one hundred percent means a full year of care at the modeled median costs more than the median household in that city earns in a year, before tax.

Costs are the published ElderCareCosts modeled median for the latest model period, carrying the survey vintage and methodology version shown on the page. Income is the Census median household income already stored against the same place record, and the survey release it came from is read from the provenance those place records carry, so it is named on the page rather than assumed.

State rows are the median of the city ratios inside that state, not a separate state-level model. A state with few priced cities is a thinner reading than one with many, and the city count is published in every row so that is visible.

Sitewide cost and data method: Methodology · Data sources · Corrections

What this cannot tell you

Median household income is all households in a city, not households with someone aged 65 and over, and not the household actually paying. Older households usually earn less than the local median, so this ratio understates the strain for most families facing this decision.

Almost nobody pays for care out of current income alone. Home equity, savings, long-term care insurance, veterans benefits, and Medicaid all sit between this ratio and what a family actually pays. Read it as a measure of how far local earnings fall short of local prices, not as a bill.

Cost figures are modeled medians, not quoted prices. A named community in the same city can sit well above or well below its city median, and assisted living pricing usually carries a care-level surcharge that a base rate does not include.

The ratio is only computed where we hold both a priced city and a Census income for the same place. Cities missing either are absent from the table rather than estimated, so this is not a complete national picture.

Income and cost are not from the same reference year. Income comes from an American Community Survey five-year release and cost from a later model period, so the ratio sets dollars of one vintage against dollars of another. The mismatch is small relative to the size of the gap, but it is real. Both vintages are named in the finding at the top of this page, in the provenance chips under the methodology, and in every row of the download.